Spicer v. McDonough, No. 22-1239 (Fed. Cir. 2023)Annotate this Case
Spicer served in the Air Force from 1958-1959 and was exposed to benzene in aircraft fuel. Years later, he developed chronic myeloid leukemia, a blood cancer. The VA recognized his leukemia as service-connected and granted him a 100 percent disability rating. Spicer developed arthritis in both knees, which required him to use a wheelchair. His scheduled knee replacement surgery was canceled because the leukemia medications lowered his hematocrit (red blood cell level). Spicer's hematocrit will never rise to a level that would permit surgery. He sought secondary service connection for his knee disability. The Board of Veterans’ Appeals and Veterans' Court affirmed the VA's denial of his claim. The statute, 38 U.S.C. 1110 establishes entitlement to service connection, providing compensation for veterans “[f]or disability resulting from personal injury suffered or disease contracted in line of duty.” The court reasoned that unless “the current state of his arthritis would not exist in the absence of his cancer or chemotherapy,” there is “no actual but-for causation.”
The Federal Circuit vacated. Section 1110 provides that the United States will pay a veteran “[f]or disability resulting from personal injury suffered or disease contracted in line of duty”; “disability” refers to a veteran’s present-day “functional impairment.” “Resulting from" requires “but-for causation,” which is not limited to bringing something about or the onset or etiological link. That language may encompass situations where the service-connected disease or injury impedes the treatment of a disability.